Baja Bliss Yoga & Meditation Retreat Registration
Please complete the form below to reserve your space to seek bliss in Baja March 2018. Can't wait to practice and explore with you!
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Emergency Contact Name and Phone Number
*
Have you practiced yoga and/or meditation before? If so, please tell me about your practice...
Do you have any chronic aches, pains or injuries that affect your mobility. If do, please describe.
Do you have any medical or mental health conditions? Please describe, know that this information will be kept confidential.
Are you on any medication? Please list.
Do you have any dietary restrictions?
How did you hear about this retreat?
What do you hope to gain from this retreat?
Is there anything else you would like me to know about you?
In the next section, you will be able to pay online. If you prefer to mail us a check or pay in person, please indicate so here. Checks should be made payable to Yoga del Sol and may be mailed to PO Box 146 Lemitar, NM 87823.
Payment
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( X )
Deposit Only - Remaining balance due by January 22, 2018.
$500.00
$
500.00
Double Occupancy Pay in Full
$2,395.00
$
2,395.00
Single Occupancy Pay in Full
$3,795.00
$
3,795.00
Total
$0.00
$
0.00
Credit Card
Signature
*
Submit
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